Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 6606 | PR |
NPI | 1043286784 |
---|---|
Provider Name | Dr. Edwin Gonzalez |
First Address | Virginia Beach, VA 23454-1151 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 09/07/2021 |